November 2, 2017

Demystifying Encopresis: Soiling Accidents in Children

Persistent soiling accidents in children may actually be due to constipation.
  • Amanda Moe photo
    Amanda Moe

    Amanda Moe, DPT, is a former employee of Restorations PT. She currently practices in Texas.

Black and white photo of boy with hand on chin in bathroom with toilet paper in backgtround

Potty-training can be a difficult process not only for children but also parents. Oftentimes children have bowel movements or fecal “accidents” in places other than the toilet. Sometimes these accidents are interpreted as a child being “too lazy” or “behavioral” when in fact the child could actually have a condition known as encopresis.

By around age 4, normal bowel functioning should be similar to that of an adult. At around this age, voluntary control of the muscles that assist with emptying the bladder/bowel occurs. There is a wide range of normal frequency of BM’s, however as a baby/child ages the frequency of BM’s decreases. At around age 4, a child should be having a bowel movement 5-9 times per week. If a child is experiencing frequent bowel accidents beyond this age encopresis may be the cause.

Encopresis is defined as an involuntary loss of stool typically experienced with stool impaction or constipation. You might ask, “but how can my child be constipated if they are having regular fecal accidents?” I hear this questions a lot, and this is where this condition can get a little confusing. The colon’s job is to remove water from stool. Thus, when a child delays the urge/need to use the restroom for a BM, the stool in the rectum becomes hard and dry making it more difficult to pass. Stool then continues to build up in the colon and the “older stool” gets harder and harder---causing a “road block.” As stool continues to back up, the colon becomes stretched which can also affect the muscles and nerves that typically assist in sensing when- and coordinating how- to use the restroom. As a child continues to eat/process digestion, more “new stool” is formed of a softer consistency. This “new soft stool” leaks around the larger mass of “old hard stool” and fecal accidents occur.

Eventually, the child does pass a very large/hard BM—but the problem doesn’t end here. The child may lose the urge for a BM when a normal size BM is ready to be expelled because previously the colon was overfilled and overstretched. This can cause the cycle to repeat itself as well as cause the child to have discomfort/pain when passing this large/hard BM. Due to pain, the child can actually be squeezing their muscles as a guarding or coping technique and develop fear around using the restroom/having a BM. The good news is that there is help out there for this!

Pediatric Pelvic Physical Therapy is a highly specialized area of rehabilitation that can address encopresis, chronic constipation, and fecal accidents, among other things. This type of physical therapy utilizes unique intervention techniques to address any tightness, weakness, or coordination issues present in the pelvic floor and pelvic girdle muscles that are typically impaired and contribute to encopresis. Amanda Moe, our Pediatric Pelvic Physical Therapist works closely with your pediatrician, gastroenterologist, or referring physician to increase the regularity of BM’s, reduce fecal accidents, and reduce medications utilized to facilitate BM’s.

For information on how to schedule and evaluation to see if your child would benefit from Pediatric Pelvic Physical Therapy, call 412-206-9202. Amanda is available for morning and after school appointments. Also, for more information on what to expect for a Pediatric Pelvic Physical Therapy evaluation, please click here.

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